Credit Card Application
When you have completed your application, take it to any TSB office or mail to P.O. Box 1260, Pigeon Forge, TN 37868
Account Type
Business
Individual
Joint Application *
* We intend to apply for joint credit
Business Legal Structure
Sole Proprietor
Partnership
Corporation
Limited Liability Company
Applicant’s Signature
Checking or NOW
Account #
Name
APPLICANT
Card Type
Visa® Gold Card
Co-Applicant’s Signature
Financial
Institution
City
Location
Other Accounts (Any Financial Institution)
Birth Date
Social Security #
Home Phone #
Address (No PO Box)
Street
City
State
Zip
Yrs at this
address
Mailing Address
Street
City
State
Zip
Yrs at this
address
Previous Address
Street
City
State
Zip
How long
Employer
Employer’s Address
Street
City
State
Business Phone #
Your Position
Zip
Previous Employer
How long
Address
Drivers License #
State Issued
Issued Date
Phone #
Relationship
Name
Address (No PO Box)
Street
City
State
Zip
Employer
Employer’s Address
Street
City
State
Mother’s Maiden Name
Number of Dependants
How long
Name of nearest Relative NOT living with you
CO-APPLICANT
Numbers of Cards
Requested:__________
Requested Limit:
$ __________________
Expiration Date
Address
Birth Date
Social Security Number
Yrs at this address
Home Phone #
How long
Business Phone #
Your Position
Zip
Previous Employer
How long
Address
Drivers License #
State Issued
Issued Date
Expiration Date
FINANCIAL INFORMATION
Verification of Income should be provided. Please supply TSB Account where ACH from employer is credited ______________________
and/or submit copies of current pay stubs.
Alimony, child support or separate maintenance
Monthly Salary
Other Monthly Income
Total $
income need not be revealed if Applicant or CoApplicant doesn’t wish it considered as a basis for
Applicant
Co-Applicant
Applicant
Co-Applicant
repaying this obligation
Source of additional income:
Assets
(Description/In name of)
Home
Value $
Obligations
(Company name & City location)
Rent/Mortgage
Real Estate
Auto
Vehicles, Boats,etc
Charge Account
Stocks, Bonds
Other
Cash, Savings
Other
Other
Other
Other
Other
Total Assets
$
$ Monthly
Payment
Account #
Total Obligations
$
$ Balance
$
Are there any unsatisfied liens or judgments
SIGN
HERE
Overdraft
Protection
INTERNAL
USE ONLY
Yes! Please enroll me in the Overdraft Protection Program. My TSB Account # is________________________. I understand that funds will be automatically
deposited to the designated checking account in $50.00 increments to cover items that would otherwise overdraw the account. This deposit will be a charge to
the credit card, and will occur only if credit availability is sufficient. $5 will be charged to the checking account per debit or check covered by this overdraft
protection.
I certify that I am at least 18 years of age and the information which I have
furnished on this application is true and complete. I have read the agreement and
agree to the terms and conditions of the account for which I am applying. I
authorize TSB to obtain information to check my credit records and statements
made in this application. I understand that you will retain this application
whether or not it is approved.
DATE APPROVED
CARD TYPE
CREDIT LINE
Applicant’s Signature
Co-Applicant’s Signature
RATE
Date
APPROVED BY
Date
# OF CARDS
Tennessee State Bank
Visa® Gold Credit Card
Applicant’s Copy- To be retained by Applicant
Interest Rates and Interest Charges
Annual Percentage Rate (APR)
Purchases
3.9% Introductory APR for six (6) billing cycles on new accounts
After that, your APR will be 8.25% (standard APR). This APR
will vary with the market based on the Prime Rate
Annual Percentage Rate (APR)
Balance Transfers
3.9% APR for six (6) billing cycles from the date of transfer
APR for Cash Advances
18.25%
After that, your APR will be 8.25% (standard APR). This APR will
vary with the market based on the Prime Rate
This APR will vary with the market based on the Prime Rate
How to Avoid Paying Interest on
Purchases*
Your due date is at least 25 days after the close of each billing cycle.
We will not charge you interest on your purchases if you pay your entire
balance by the due date each month*.
Minimum Interest Charge
For Credit Card Tips from the Federal
Reserve Board
None
To learn more about factors to consider when applying for or using
a credit card, visit the website of the Consumer Financial
Protection Bureau at http://www.consumerfinance.gov/learnmore.
Fees
Annual Fee
Transaction Fees
 Cash Advance
None

Either $5 or 4% of the amount of each cash advance, whichever
is greater (maximum fee: $50).

Balance Transfer Fee

Either $5 or 4% of the amount of each transfer, whichever is
greater (maximum fee: $50).

Foreign Transaction

1% of each transaction in U.S. dollars.

ATM Fee

None

Up to $35

Up to $35
Penalty Fees
 Late Payment

Returned Payment
How We Will Calculate Your Balance: We use a method called “average daily balance (including new
purchases)”.
*Finance charges on cash advances and balance transfers are assessed from the day you take the cash advance
or balance transfer until the day we receive payment in full, there is no grace period. Transactions for overdraft
protection services are cash advances.
Card Replacement Fee:
Documentation Copies:
Expedited Delivery Fee:
Stop Payment Fee:
$5—We may charge this fee for any replacement card ordered by the cardholder.
$3/copy—We may charge this fee for each copy provided.
$40—We may charge this fee if you request expedited delivery of new or replacement
cards.
$30—We may charge this fee if you request a stop payment on an automated recurring
charge to your credit card account.
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CHARITY CARD: You may elect at application to carry a charity card to show your support of the Friends of the
Smokies for an annual contribution of $10 per charity card issued on the account. This contribution will be
charged to your credit card account at account opening and annually thereafter. One hundred percent (100%) of
contributions collected are given to the Friends of the Smokies, a non-profit organization dedicated to the
preservation and protection of the Great Smoky Mountains. You may cancel this election at any time by calling
Credit Card Services at (865)429-2273. If cancelled, your card will be reissued with a standard design.
Disclosure Effective 05.01.2014. Information about the costs and the rates is accurate as of April 2014. This
information may have changed after that date. You may contact us to find out what may have changed by
directing inquiries to Tennessee State Bank, Attention Bank Card Services, P.O. Box 1260, Pigeon Forge, TN
37868-1260; or call us toll-free at (877) 908-4TSB (4872).
USA Patriot Act
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT, UPDATING AN
ACCOUNT OR PERFORMING TRANSACTIONS
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all
financial institutions to obtain, verify, and record information that identifies each person who opens or updates an
account or performs transactions.
What this means to you: When you open or update an account or perform a transaction, we will ask for your
name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your
driver’s license or other identifying documents and retain copies of those documents.
When opening or updating an account, we may also ask other information of you required by current regulatory
guidance such as if you perform money services business activities; if you may be related to any foreign political
official; and what levels of different types of transactions you expect to perform in your account.
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